Diaphyseal femoral fractures; outcome treated with close vs open

The femur fractures usually happen with oomph forces like motor vehicle accidents. To assess the mode of injury and complications of the management, in diaphyseal femoral fractures, in comparison of close versus open intramedullary interlocking nail [IMN]. Experimental and comparative study. April 2013 to March 2014. Department of Orthopaedic Surgery, Peoples University of Medical and Health sciences, Nawabshah. The cases were divided into two groups A and B. Group A was treated by open nailing [n = 20] and group B by close nailing [n = 20], all the cases were operated within 48 hours of admission. All the data were recorded on well structured proforma. Serial radiographies were performed at 3, 6, 12 weeks, and 6 months; additional radiographies were performed as needed postoperatively. Knee, ankle, and hip motions were begun and protected weight bearing was started on the second day postoperatively and increased gradually to full WB depending on x-ray findings of callus formation. The patients were followed for two years. Results of open and closed I.M.N were assessed and the complications if any were observed over a mean follow-up period of two years. The mean age in group A was 29.40 years and the mean age in group B was 30.45 years. Out of 40 cases, 32[80.0%] were males with male to female ratio 1:4. Mean +/- SD hospital stay was 19.80 +/- 14.60 days in group A, and 17.90 +/- 5.95 days in group B [p value 0.55]. Average time between injury and admission was 1.53 days [n = 40], in the group A it was 1.05 days, and in the group B it was 2.0 days [p value 0.03]. The average of time between injury and operation in the group A was 8.75 days, and in the group B, it was 8.20 days, [p value 0.71]. The average of time between admission and discharge in the group A was 11.0 days, and in the group B was 9.15 days, [p value 0.55]. Mean +/- SD union time was 11.70 +/- 6.45 weeks, in group A and 11.90 +/- 5.77 weeks, in group B. [p value 0.91]. All the patients had full ranged of hip motion and 2 [10.0%] patients of group A had mild limitation of knee motion with a flexion ranges between 80 and 110 degrees. Final functional results based on Thoresen BO criteria16. Excellent results were observed in 19 [47.5%] cases, out of them 5[25.0%] were in group A and 14[70.0%] were in group B. Good results were found in 13[32.5%] patients, out of these 7[35.0%] were in group A and 6[30.0%] were in group. Fair and poor results were detected in 4[10.0%] cases of group A. Road traffic accidents by motorcycle was found the commonest [47.5%] cause of femur fracture, a few complications were observed in open interlocking nailing as compared to closed interlocking nails

Diaphyseal tibial fractures; closed intramedullary interlocking nailing

To determine the outcome and consequences of close intramedullary interlocking nailing in diaphyseal tibial fractures and to observe the hospital stay and complications in this method of treatment. The study was conducted in department of orthopaedic unit-I at Liaquat University Hospital Jamshoro/Hyderabad during Jan 2011 to June 2012. The present study constituted on 43 patients, 3 cases were dropped during follow up and the rest 40 cases completed 1 year post operative follow up. After having routine laboratory investigations and necessary x - rays, the stable patients were operated for intramedullary interlocking nailing on routine operating days. The patients were assessed according to the criteria mentioned in follow up proforma from date and time of arrival to final visit in review clinic and results were tabulated. Among 40 patients, 38 [95%] were males and 02 [5%] females. The age ranges from 17 to 50 years with mean age of 32.23 years. There were 25 close fractures [62.5%] 15 open fractures [37.5%], among these 13 [32.5%] were Gustilo type I and 2 [5%] were of type II. The mode of injury in majority [75%] of cases was road traffic accident. Good union achieved in 39 cases [97.5%] in 17.53 weeks. But only 1 [2.5%] case unfortunately went in infected non union and was converted into Illizarove external Fixation. The main complication observed after surgery was loosening of screw in 3 [7.5%] cases. Deep infection was observed in the medullary cavity in 3[7.5%] cases [table-V]. It has been observed in analyzing the functional outcome of these patients that majority [80%] of cases was able to sit on bed in 12-24 hours and was able to stand in 24-48 hours. In next 24 hours after surgery 75% of patients were pain free. The mean hospital stay in these cases was 8.53 days and by the 48th week all of cases were able to join their job except one case in which non union observed due to infection. The data from the current study reveals that intramedullary interlocking nailing of closed and open grade I and II fractures is a safe technique. It combines a high rate of union with a low complication rate, less hospitalization and early return to job